Sonaglioni Andrea, Lonati Chiara, Scime' Valentina, Nicolosi Gian Luigi, Bruno Antonino, Lombardo Michele, Harari Sergio
Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy.
Division of Internal Medicine, IRCCS MultiMedica, 20123 Milan, Italy.
J Clin Med. 2025 Jan 10;14(2):426. doi: 10.3390/jcm14020426.
During the last few years, significant pathophysiological differences between heart failure (HF) patients with "normal" ejection fraction (EF) (50% to 64%) and those with supra-normal EF (≥65%) have been highlighted. However, these distinct EF phenotypes have been poorly investigated in elderly patients aged ≥70 y. Accordingly, the present study aimed at assessing the clinical and echocardiographic characteristics of a retrospective cohort of elderly HFpEF patients (aged ≥ 70 y), categorized on the basis of "normal" EF (50 to 64%) or "supra-normal" EF (≥65%). All patients aged ≥ 70 y that were discharged from our Institution with a first diagnosis of HF with preserved EF (HFpEF) between January 2020 and March 2021 entered the study. All patients underwent clinical evaluation, blood tests, and transthoracic echocardiography. The primary endpoint was "all-cause mortality", while the secondary one was the composite "all-cause mortality or rehospitalization for all causes" over a mid-term follow-up. A total of 200 HFpEF patients (86.4 ± 6.6 y, 70% females) were retrospectively evaluated. The "normal" EF group ( = 99) and the "supra-normal" EF one ( = 101) were separately analyzed. Compared to patients with "normal" EF, those with "supra-normal" EF were older, with greater comorbidity burden, and moderate-to-severe frailty status. The mean follow-up duration was 3.6 ± 0.3 y. During follow-up, 79 patients died, and 73 were rehospitalized. In the multivariate Cox regression analysis, age (HR 1.09, 95% CI 1.03-1.16, = 0.002), EF (HR 1.08, 95% CI 1.03-1.14, = 0.004), tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio (HR 0.14, 95% CI 0.03-0.61, = 0.009), and infectious disease occurring during the baseline stay (HR 7.23, 95% CI 2.41-21.6, < 0.001) were independently associated with the primary endpoint in the whole study population. EF (HR 1.04, 95% CI 1.01-1.07, = 0.02) also predicted the secondary endpoint. EF ≥65% was the best cut-off to predict both endpoints. "Supra-normal" EF (≥65%) at hospital admission is independently associated with all-cause mortality and rehospitalization for all causes in elderly HFpEF patients over a mid-term follow-up.
在过去几年中，射血分数（EF）“正常”（50%至64%）的心力衰竭（HF）患者与射血分数超正常（≥65%）的患者之间显著的病理生理差异已受到关注。然而，在70岁及以上的老年患者中，这些不同的EF表型尚未得到充分研究。因此，本研究旨在评估一组回顾性队列中≥70岁老年射血分数保留的心力衰竭（HFpEF）患者的临床和超声心动图特征，这些患者根据“正常”EF（50%至64%）或“超正常”EF（≥65%）进行分类。2020年1月至2021年3月期间，所有从我们机构首次诊断为射血分数保留的心力衰竭（HFpEF）并出院的≥70岁患者均纳入本研究。所有患者均接受了临床评估、血液检查和经胸超声心动图检查。主要终点为“全因死亡率”，次要终点为中期随访期间的复合终点“全因死亡率或因任何原因再次住院”。共对200例HFpEF患者（86.4±6.6岁，70%为女性）进行了回顾性评估。对“正常”EF组（n = 99）和“超正常”EF组（n = 101）分别进行分析。与“正常”EF患者相比，“超正常”EF患者年龄更大，合并症负担更重，且处于中度至重度衰弱状态。平均随访时间为3.6±0.3年。随访期间，79例患者死亡，73例再次住院。在多因素Cox回归分析中，年龄（HR 1.09，95%CI 1.03 - 1.16，P = 0.002）、EF（HR 1.08，95%CI 1.03 - 1.14，P = 0.004）、三尖瓣环平面收缩期位移（TAPSE）/收缩期肺动脉压（sPAP）比值（HR 0.14，95%CI 0.03 - 0.61，P = 0.009）以及基线住院期间发生的传染病（HR 7.23，95%CI 2.41 - 21.6，P < 0.001）在整个研究人群中与主要终点独立相关。EF（HR 1.04，95%CI 1.01 - 1.07，P = 0.02）也可预测次要终点。EF≥65%是预测两个终点的最佳切点。入院时“超正常”EF（≥65%）与老年HFpEF患者中期随访期间的全因死亡率和因任何原因再次住院独立相关。
